Entries for 2010

This quote by Governor Perdue on WRAL captured her fundamental political problem.

“I’m going to make a lot of people unhappy, and I’m sorry.”

First, let’s recall what people look for in leaders. It’s not just what they say, it’s how they say it. The most successful – Roosevelt, Kennedy, Reagan, Clinton, Hunt – communicate optimism, even in the face of tough challenges.

Now, listen to what she said – and how she said it.

She looked like the most unpleasant school teacher you ever had. Her message is about making people “unhappy.” And it’s about her, not the state.

Here’s the right quote: “This is going to be a tough year. But North Carolina has overcome tough times before, and we can do it again.”

While I was writing this, I got an email from a reader who noticed another thing: “Was it wise for Bev to have her press meeting in the opulently-decorated-for-Christmas mansion and how wise it is for her to be wearing huge diamond earrings when she's talking austerity? If they're fake, then double-shame on her.”

The Civitas Institute has published a right interesting report about how much North Carolina’s Senators and Congressmen have requested earmarks over the last year and the winner is…

In the Senate when it comes to grabbing for the loot Kay Hagan whipped Richard Burr hands down, reaching into the Treasury to spend $3 to every $1 of Burr’s. (Hagan’s total: $724 million. Burr’s total: $287 million.)

Among the vital causes Hagan espoused (as essential for the federal government fund) were $1.7 million for weed control at Lake Gaston, $1 million for ‘Soccer for Success’ and $1.6 million for Advanced Nanoengineered Hybrid Composite Material Systems for Wind Mill Blades.

The winner hands down among our Congressional delegation was Bob Etheridge who led the other Congressmen easily by $10 million. (Total Spent by Etheridge: $238 million).

Raleigh out-hustled all other North Carolina cities by grabbing for $124 million in earmarks – though it’s not quite clear why the Capital City needed $300,000 for Beaver Management (courtesy of Senator Kay Hagan and Congressman David Price).

Once again, we interrupt this blog to bring you a word from our clients.

I promise not to turn this into a long-running home-care versus assisted-living debate. But Lou Wilson with the N.C. Association of Long-Term Care Facilities takes issue with Carter’s blog “Grit” below.

Herewith Lou:

“Mentally ill people have not just started living in rest homes. They have been there since the homes were first old county homes, and that was more than 60 years ago.

“What Carter didn’t say is that the taxpayer ALSO pays for housing and food for Medicaid-eligible people who live in their homes. Some of them even receive the same kind of check called special assistance that the folks in the rest homes get – and then on top of that receive more taxpayer money for food stamps, meals-on-wheels, fuel assistance, in-home aide services, Section 8 Housing, adult day care (that’s when the government pays for them to go somewhere else for daytime hours). So go figure!

“It only costs the taxpayer $435 a month to pay for housing, food, activities, taxes, laundry and all the other costs associated with keeping a person in a rest home. The resident pays the rest of the cost through their own resources. So when you count up all that the rest home gets, it’s a little over $11,000 a year in taxpayer money! The rest home folks wish they got 22,000 Carter!”

Twenty-six years ago after the fourth Helms-Hunt debate I walked up onto the back of the stage and stood waiting for Jesse – as he talked to reporters – and suddenly the crowd shifted and I found myself standing face to face with Jim Hunt in the flesh – for the first time.

To say there wasn’t any good will between the Hunt folks and Helms folks in October of 1984 is an understatement – we’d been going at it hammer and tongs making the political equivalent of nuclear war on each other for over a year; so as I faced Hunt there was a moments ‘awkward pause’ where all I could manage to do was nod and mumble a dead-pan, “Governor,” trying to at least sound polite but not really succeeding.

Then Hunt stuck out his hand, half-smiled, and said, “Well, at least no one can say we sat it out in our Ivory Towers.”

Then the crowd shifted again and he was gone.

For the last four years Gary’s been working on a biography of Jim Hunt and the other day he came by the office and gave me a copy for Christmas. It’s a riveting story – a rare look at three decades of Democratic politics from behind the curtain and I read it straight through in three sittings.

As Gary was leaving he said, You might want to look at the inscription.

I opened the title page and there were two inscriptions. One was a personal note from Gary. And the other was a note from North Carolina’s ‘Governor for Life’ and Jesse Helms’ nemesis Jim Hunt. He’d written:

Gary and I have a bit of grit in the gears of our now going on decade long friendship and I’m afraid I’m the one who caused the problem.

Sometimes, if it’s a good story about how government works (or doesn’t work), I write about what I see or learn while working with a client – and I’ve learned a lot of great stories about Governor Perdue’s Department of Health and Human Services foibles (like granting no bid contracts to former lobbyist and now Secretary Lanier Cansler’s clients) while working with my friends the Hospice and the Home Care folks. The rub is, occasionally, when I write one of those stories it irritates Gary’s friends the Rest Homes folks – which is natural as the two groups are fierce competitors.

I expect at times that’s caused Gary a problem but he’s been too courteous to complain. In fact, he’s hardly ever mentioned it. But, at last, the other day he did write an article responding which was, by the way, a paradigm of the kind of politeness that only comes with age and wisdom and which to my way of thinking is a rare sign there is such a thing as human ‘progress’ – after all, not too many years ago when Gary and I had a disagreement the next step would have been to pull out the blunderbusses and have at it (in the form of negative TV ads) with no courtesy at all.

So first, Gary, let me say if anything I’ve written has caused you any inconvenience at all – I apologize.

Second, I apologize again – because I’m about to do it again.

At my age there’s just about only one temptation I can no longer resist: A good story. I’m no admirer of Governor Jim Hunt but that’s why I read Gary’s biography of Hunt straight through in three sittings. It’s a riveting story. And, in that same vein, the story below is just too good to resist telling – so here goes:

The gray eminences at the Department of Health and Human Services had a problem: After closing a good part of the state’s mental hospitals and then bungling how to set up a new regimen to care for impoverished mental patients they had no place – or not enough places – to care for the mentally ill. How DHHS solved their problem was straightforward: They shuffled six thousand schizophrenics and other mental patients on Medicaid into Rest Homes – which were meant to care for the elderly. And which, I’m suspecting, was a shock to Rest Home owners who had their hands full already.

The result was a first-class catastrophe and after four murders, where violent mental patients killed other patients in Rest Homes, Disability Rights (a non-profit group that advocates for the mentally ill) had had enough: It called on President Obama’s Justice Department to investigate and the President is obliging – the Justice Department’s about to investigate Governor Perdue’s warehousing mental patients in Rest Homes.

Now you’d think the folks who run Rest Homes would be tickled to death to get out of the business of caring for the mentally ill – which they never meant to get into in the first place.

But, you’d be dead wrong.

The way Rest Home folks saw it Disability Rights hadn’t just attacked Governor Perdue –it had attacked them. So they fired a broadside of their own right back saying if the do-gooders really gave a toot about mental patients, instead of trying to turn them out of Rest Homes they’d get the state to pay the Rest Homes more money to care for them properly.

Now maybe that did or maybe it didn’t make sense.

But there was a second surprise in the Rest Home folks broadside: The way they saw it Disability Rights calling on Obama’s Justice Department to investigate them was a sure sign there was sinister conspiracy was afoot between their arch-competitors the In-Home Care folks and the do-gooders.

Now if an elderly aunt or grandmother can’t, say, bathe herself or go to the bathroom on her own and if she’s on Medicaid in North Carolina she has choices: She can apply for part-time care in her own home. Or she can apply to go into a Rest Home.

The Rest Home folks studied the Disability Rights complaint, added one plus one, came up with a conspiracy, and, then, when they blasted Disability Rights ripped into the Home Care folks too – who’ve never even dreamed of caring for schizophrenics.

Right quickly the Rest Home folks let fly with a haymaker saying that on average the In-Home Care folks charge a whopping $6,892 a year to provide 2.6 hours a day of care to folks who can’t bath or go to the bathroom alone while the Rest Home folks provide the exact same services 24 hours a day for a little less money.

Which sure sounded like Rest Homes are a great deal compared to In-Home Care.

What’s called ‘personal care’ for elderly patients – say, for bathing – costs the government about the same whether the care’s provided in a patient’s home or in a Rest Home. But there’s one big difference: If a Medicaid patient goes into a Rest Home the government also pays for his food and housing and heat and air-conditioning and electricity and the bed he sleeps in – all of which the patient pays for himself (or herself) if he stays at home. In fact, in North Carolina the government’s made it easier for a Medicaid patient to get full-time care in a Rest Home than part-time care in their own home.

So treating a patient in his own home costs the state a lot less than it costs to treat the same patient in a Rest Home ($22,457) which is why most states, with the odd exception of North Carolina, prefer to care for patients in their own homes.

Now, what’s the moral of this story? Consider the facts: The state shutters mental hospitals, has no place to care for patients, ships them into Rest Homes (which were never meant to care for them), the do-gooders object and the Rest Home folks – faced with the prospect of losing six thousand paying patients – roar bloody murder and declare the real answer is to pay them more money.

Here’s the point: It turns out treating mental illness is a near-perfect metaphor for how government works.

You wouldn’t want the people who put together the new building code to build your house.

The Building Code Council Tuesday adopted rules to make new commercial and residential buildings more energy-efficient. But they were afraid the changes would increase the cost of homes when the home-buying market is in a depression. So they compromised on – wait for it, yes – safety requirements!

The accounts by Mark Binker of the Greensboro News & Record and David Bracken in the N&O made it all look like a comedy of errors.

Governor Perdue seemed anxious to distance herself from the “offsets” presented in her name: "The fact of the matter is these people are appointed to do a job," she said of the council. “It's up to them to see that safety isn't eroded."

But one of her appointees, the director of emergency services for GuilfordCounty said of the Governor, "I dare say she doesn't know what her name has been attached to."

Some in the business community say the Governor was too eager to placate environmentalists – even at the risk of raising house prices and, now, looking wobbly.

First, he’s going to get a win. Congress will pass the tax cut/stimulus bill he worked out with Republicans.

Even better for him, congressional Democrats – who had become a political anchor around the President’s neck – are mad about the bill.

And how can you call Obama a socialist when Congress’ only real socialist, Senator Bernie Sanders, filibusters with rage against the bill?

Now comes another political gift: a Republican federal judge rules unconstitutional the requirement that every American buy health insurance.

Surely this is a fight Obama wants. He wants any fight that focuses on a specific part of health-care reform rather than an ill-defined monster called “Obamacare.”

Do Republicans who oppose the health-insurance mandate also think it’s unconstitutional to make every driver buy car insurance? If you get hit by a driver who doesn’t have insurance, you pay. And that’s what happens when people who don’t have health insurance go to the hospital: You pay.

And Obama has a big ally on the mandate issue: the insurance industry.

But Carter forces my hand. He has posted several blogs about the assisted-living industry, also known as adult-care homes. They’re my clients: the N.C. Association of Long-Term Care Facilities and its director, Lou Wilson.

Carter reflects the views of the home-health care industry, his client. That industry has come under scrutiny from the state because it has grown like crazy. In fact, North Carolina spends more on home-health care than most other states.

So the home-care people attack the assisted-living people. The home-care people argue – and it’s understandable – that all of us want to stay in our own homes instead of living in an assisted-living home. Plus, the home-care people want the state dollars that might otherwise go to adult-care homes.

But sometimes the truth gets lost in this fight for funds. Facts like:

- Adult-care homes are chronically underfunded by the state. The state reimburses only about 65 percent of their Medicaid costs, compared to 100 % percent of home-care providers. In fact, adult-care homes are the only providers whose reimbursement rate is set by the legislature instead of DHHS. How does that make sense?

- Adult-care homes are more highly regulated than the hundreds of small, scattered home-care providers around the state.

- Like it or not, not everybody can stay in their own home, even if they want to. Some assisted-living residents would be neglected and even abused at home.

Lou and her members don’t deny there are problems in some adult-care homes. But critics shouldn’t deny that the state is short-changing the homes.